Deep Brain Stimulation for Chronic Pain Intracranial Targets, Clinical Outcomes, and Trial Design Considerations

• Type of Material: Article
• Authors: Nicholas Boulis, Emory University; Orion Paul Keifer, Jr, Emory University; Jonathan P. Riley, Emory University
• Language: English
• Date: 2014-10-01
• Publisher: WB Saunders
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.nec.2014.07.009
• Title of Journal or Parent Work: Neurosurgery Clinics of North America
• ISSN: 1042-3680
• Volume: 25
• Issue: 4
• Start Page: 671
• End Page: +
• Keywords: Neurosciences & Neurology; PHANTOM LIMB PAIN; RELAY NUCLEUS STIMULATION; PERIVENTRICULAR GRAY-MATTER; Clinical trial design; TERM-FOLLOW-UP; Chronic pain; MOTOR CORTEX STIMULATION; ADVANCED PARKINSONS-DISEASE; ELECTRICAL-STIMULATION; Anterior cingulate cortex; Periyentricular and periaqueductal gray; Deep brain stimulation; MEDIAN-PARAFASCICULAR COMPLEX; Life Sciences & Biomedicine; INTRACTABLE CLUSTER HEADACHE; Intracranial stimulation; Surgery; Science & Technology; Sensory thalamus; Clinical Neurology; OF-THE-LITERATURE
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

For over half a century, neurosurgeons have attempted to treat pain from a diversity of causes using acute and chronic intracranial stimulation. Targets of stimulation have included the sensory thalamus, periventricular and periaqueductal gray, the septum, the internal capsule, the motor cortex, posterior hypothalamus, and more recently, the anterior cingulate cortex. The current work focuses on presenting and evaluating the evidence for the efficacy of these targets in a historical context while also highlighting the major challenges to having a double-blind placebo-controlled clinical trial. Considerations for pain research in general and use of intracranial targets specifically are included.